| NPI | 1962690743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA CORNELL Cred Coordinator 410-398-4679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0059266) |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2007-11-19 |